Not recommended for persons with congenital long QT syndrome, bradycardia, hypokalemia, or hypomagnesemia.

Not an ideal choice for patients with renal impairment because of the potential for accumulation.

Avoid in persons prone to overdose.

Escitalopram (Lexapro)

Low potential for drug interactions

Easy to titrate.

Significantly more expensive than generic SSRIs.

Not perfect choice for persons with renal impairment.

Should not be used to treat depression failed to respond to other SSRIs, but may be considered for people with severe depression who responded to other SSRIs but have been unable to tolerate side effects.

Fluoxetine (Prozac)

Less likely than other SSRIs to cause discontinuation syndrome. Basically, fluoxetine self-tapers.

Poor tolerability: patients on venlafaxine are more likely to discontinue treatment early due to side effects, than those on other antidepressants.

Norepinephrine and dopamine reuptake inhibitors (NDRIs)

Bupropion (Wellbutrin)

Favorable side effect profile!

Free of sexual side effects.

Does not cause weight gain.

Useful in smoking cessation and ADHD.

"Energizing" or stimulating effect.

Can worsen anxiety.

Increases seizure risk.

Less robust antidepressant effect.

Unique antidepressant - most closely resembles the action of psychostimulants.

Avoid in persons with history of epilepsy, seizures, head trauma, alcohol dependence.

Useful augmentation therapy for SSRI’s.

Norepinephrine and Dopamine Reuptake Inhibitors (NDRIs)

Remeron (mirtazapine)

Faster onset of antidepressant action.

Lack of anticholinergic activity.

No sexual dysfunction, no nausea or gastrointestinal problems.

Weight gain and sedation!

Higher weight gain than with any of the SSRIs or SNRIs.

Starts to work more quickly than other medications for depression.

Sleep-promoting.

Appetite stimulation.

Other Antidepressants

Trazodone (Desyrel)

Particularly useful for insomnia.

May help with anxiety, agitation, hostility.

No anticholinergic effects.

Frequently causes somnolence.

Risk of priaprism.

Postural hypotension.

Marked sedative and hypnotic effects may be of particular benefit in people with insomnia, although disadvantageous to others.

The Best Antidepressant

First of all, antidepressant that is universally effective for everyone does not exist: many depressed patients do not experience a satisfactory clinical benefit from the initial treatment. It is impossible to recommend antidepressant effective for all patients.

Sertraline (Zoloft) and escitalopram (Lexapro) are considered to have the best combination of efficacy and acceptability [1]. Sertraline may be the best choice when starting treatment for moderate to severe major depression in adults because it has the most favourable balance between benefits, adverse effects, and acquisition cost.